Provider Demographics
NPI:1669544326
Name:RAYGOR, JYOTSANA P (MD)
Entity type:Individual
Prefix:
First Name:JYOTSANA
Middle Name:P
Last Name:RAYGOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:P
Other - Last Name:RAYGOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-2210
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4189
Practice Address - Street 1:2240 GLADSTONE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5126
Practice Address - Country:US
Practice Address - Phone:925-431-2100
Practice Address - Fax:925-431-1234
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A418620Medicaid
00A418620Medicare ID - Type Unspecified
CA00A418620Medicaid